By: Karen Guo
When the novel coronavirus first began to infect people around the world, medical experts urged everyone to limit physical contact with others and to stay at home as much as possible. As the virus became a global pandemic, stay-at-home orders, lockdowns, and other similar restrictions were placed on communities everywhere to mitigate the spread of the disease. Yet, there are people who have ignored such orders, some even choosing to actively protest against them, ensuing the condemnation of many others, including public health officials.
As coronavirus cases rose in the States, the murder of George Floyd, Breonna Taylor, and other Black people at the hands of police catalyzed the start of numerous protests nationwide in support of the Black Lives Matter movement and police abolition. Though these protests do not necessarily follow social distancing guidelines, they should not be regarded with the same attitude of condemnation and is, in fact, necessary to address the striking racial disparities in health.
Earlier in June, a group of disease specialists and public health professionals wrote an open letter to address the protests for Black lives during the pandemic. The goal of the letter was to make a clear distinction between protestors who are rejecting stay-at-home orders and protestors who are pushing back against anti-Black racism. The writers urge other public health professionals to support those demonstrating against racism as it affects public health issues just as racism plagues law enforcement institutions. In the words of the letter, “White supremacy is a lethal public health issue that predates and contributes to COVID-19.”
Within weeks of rising coronavirus cases and deaths in the States, one thing was made glaringly apparent. Black people were, and continue to die at a disproportionately high rate from the virus throughout the entire nation. According to data collected by The COVID Tracking Project, Black people only account for 13% of the total US population but represent 23% of COVID-19 deaths, meaning that they are dying at a rate 1.5 times higher than expected. Since late June, the virus has taken more than 25,000 Black lives. In NPR’s analysis of this data, they found that Black people are dying at a higher rate compared to their population in 32 states, four of which Black people are dying at a rate that is three or more times greater than their share of the population. These disparities are not the result of biological differences but rather from a long history of systemic racism, which anthropologist Clarence Gravlee defines as the “policies and practices that create and enforce racial inequalities in major systems of society.”
Systemic Racism in the Health Care System
To begin to understand why the coronavirus affects Black people disproportionately, one must look at the ways that systemic racism has impacted the health care system. When testing sites for the virus first began to appear across the country, testing locations were mostly located in predominately White neighborhoods in states such as Texas, New York, and Illinois. In addition, many of these testing locations operated as a drive-through site only, requiring those who want to get tested to have access to a car. Both of these factors create greater obstacles for communities of color and less affluent communities to have access to testing. Without easy access to testing, it is much more difficult to detect potential infections and isolate cases early to control the spread of the virus. Although testing sites have become more accessible as additional locations are being set up throughout the nation and certain sites offering walk-up testing, the way initial testing sites were set up has already had its detrimental effects.
In addition to the biases present in early efforts to detect infections, racial bias also exists in the implementation of medical treatment. Science and those who practice medicine are not immune to the effects of racism even though they are meant to be objective. In a study published by the American Journal of Public Health, health care professionals who have participated in previous studies have demonstrated implicit racial and ethnic biases in 14 out of 15 cases. Additionally, a survey done in 2016 by the National Academy of Sciences discovered that half of 222 interviewed White medical students and residents still believed in physiological differences in Black people that have no scientific basis. Though these health care professionals may not be overtly racist, their covertly racist beliefs affect the way they provide treatment towards their patients. Their biases may cause them to hold certain assumptions such as the belief that Black people have higher pain tolerance, speak to Black patients in a more dominating or condescending tone, and even recommend different treatments than they would otherwise recommend a White patient. These differences in medical treatment can cause unnecessary harm and suffering, and decreases the quality of medical care for Black people during and before the coronavirus pandemic.
The biases that health care professionals hold are the result of a health care system built on a long history of killing and disregarding Black bodies. Advances in science that now benefit countless people were sometimes made through medical experimentation on Black people. One infamous example is the work of 19th-century Dr. James Marion Sims, commonly regarded as the father of gynecology. Sims experimented on enslaved Black women over a course of 4 years to develop surgical techniques used to treat vesicovaginal fistulas. The women he experimented on never consented to his experimental “surgeries” and were not given anesthesia when undergoing painful procedures. In addition, Sims experimented on Black babies to test racially-based hypotheses such as the belief that the skulls of Black babies grow faster than White babies. Another similar case is the Tuskegee Syphilis Experiment that spanned from 1932 to 1972. This experiment was organized by the US Public Health Service, an agency under the federal government, and deceived 600 Black men into believing that they were getting treatment when in reality the researchers used them to observe the consequences of untreated syphilis. The men were never provided with the proper treatment in the 40 years of the experiment even though penicillin was accepted as a treatment for syphilis halfway in 1947.
Sims and the Tuskegee Syphilis Experiment were not isolated cases. Medical experimentation on Black bodies occurred throughout American history. Though such blatant violations of human lives may no longer occur today, this history of experimentation and the racial biases that current health professionals still hold contribute to a deep distrust that the Black community has to medical professionals and prevent Black people from receiving proper medical care.
Disparities Exasperated by the COVID-19 Pandemic
The disparities seen during the coronavirus pandemic can also be attributed to the disinvestment in Black communities. Neighborhoods with less wealth have less access to healthy foods, fewer places to exercise, have more polluted air, and tend to be more densely populated. This causes the residents of these neighborhoods to have higher rates of chronic diseases such as high blood pressure and diabetes, increasing the risk of death or other serious complications from being infected by the coronavirus. Densely populated areas also make it difficult for people to properly follow social distancing guidelines, causing them to be more at risk for exposure and spread of the virus.
The disinvestment in Black communities has greatly impacted the distribution of wealth among people in the States. Data from the Federal Reserve Board show that in 2017, for every dollar of wealth in median White households, median black households have about a dime. This wealth inequality traps Black people in low paying jobs, causing them to be overrepresented in the essential worker population. According to the Center for Economic Policy and Research, Black people make up 11% of the workforce but represent 17% of all frontline industries. Though essential workers continue work throughout stay-at-home orders, the lack of proper PPE and hazard pay for essential workers puts them at greater risk to become infected with the virus as they interact with other people for work.
The large wealth gap of Black families and predominately Black communities as compared to their White counterparts are the results of decades of racist policies set by the government, preventing the social and economic mobility of Black people. One of these policies was the 1949 Housing Act, which encouraged White families to move into suburban areas in the postwar era. To accommodate the new families of returning war veterans, the Federal Housing Administration subsidized the mass-production of suburban homes. However, they explicitly required that these homes must not be sold, or even resold, to Black Americans. This allowed the suburbs to become predominately White neighborhoods while keeping Black people in the cities. Around the same time, the Home Owners’ Loan Corporation began a process now known as “redlining” where they determined the mortgage value of certain neighborhoods. However, this process was largely driven by racial biases as neighborhoods with large Black populations were marked as high-risk for mortgage lenders while predominately White neighborhoods were low-risk.
As White families moved into the suburbs, neighborhoods became more and more segregated, both in terms of race and wealth. Redlining caused the monetary values of White suburban homes to increase, while houses and property located in Black communities slowly lost its value. Even after many decades since the Housing Act and a ban on redlining, a study done by the National Community Reinvestment Coalition determined that most of the neighborhoods that were marked as high-risk in the past are more likely to be low-income and minority neighborhoods today.
Both health care inequality and disinvestment in Black communities has caused the overrepresentation of Black people in the reported cases and deaths of the coronavirus and are the result of anti-Black racism. The racial biases that exist in health care and the federal policies that created racially segregated neighborhoods have cost countless Black lives. If Black people were dying at the same rate from the virus as White people, at least 14,000 Black people would still be alive today. As people march to the streets to demand justice for the Black lives lost through police brutality and for the abolition of the police, there must also be a similar focus on how racism impacts health care. Anti-Black racism needs to be considered a public health crisis, as it has by the Toronto Board of Health, and its effects on public health must be addressed to achieve greater racial justice.
Several hundred doctors, nurses and medical professionals came together to protest against police brutality and the death of George Floyd at Barnes-Jewish Hospital on June 5, 2020 in St Louis, Missouri.
Photo by Michael B. Thomas/Getty Images
It’s NOT New.
Anti-black racism in health care didn’t only become an issue during the pandemic. There have been racial disparities in health before the virus. Black people have an elevated death rate for eight of the ten leading causes of death, including heart disease, cancer, diabetes, and liver cirrhosis. Black mothers experience maternal mortality at a rate of two to three times greater than White mothers. Addressing and actively reforming the health care system is long overdue and changes must be made. There must be more effort to collect race-based health data in order to better understand the extent of health disparities among different communities and people. Currently, eight states have not reported race and ethnicity data of COVID-19 infections and deaths. As explained by Bee Quammie in their article “Anti-Black Racism Was Already A Pandemic”, “the refusal to collect rigorous race-based health data is anti-Blackness in action. It allows governments and gatekeepers the ability to dismiss anecdotal evidence raised by the community, and it allows them to be slow to act.” Additionally, there must be work done to create more public awareness of the ways in which the health care system is not immune to racism, increase the amount of Black medical professionals, repair the relationship between health professions and Black communities, and support the current protests against anti-Black racism.
Planning to participate in protests or collective action? Here’s a checklist to help you prepare with a focus on Staying Safe at Protests and Collective Action. Here’s another post by this author on Why Mutual Aid is Important During the Pandemic.
To learn more about the topics mentioned in this blog, check out the following books: